Rehab Knee ACL Reconstruction Protocol
  • Sports Medicine

  • Knee Surgery

  • Shoulder Surgery

  • Elbow Surgery

  • Hip Surgery

  • Ankle Surgery

  • Arthroscopic Surgery

Rehab Knee ACL Reconstruction Protocol

Phase I: Acute


  • Alleviate acute pain and swelling
  • Increase ROM 0-90° (emphasize 0° extension)
  • Increase hamstring and quadriceps strength
  • Promote comfortable ambulation WBAT with brace and crutches
  • Maintain cardiovascular conditioning

Plan: (0-2 weeks)

  • Patellar mobilization
  • PROM positioning for knee extension
  • ROM
  • Heel/wall slides w/o brace
  • ½ revolution non-resisted bike for knee flexion – progress to full revolution when patient reaches 110°.
  • Hamstring and quadriceps co-contraction
  • Hamstring and calf stretching
  • 4-Quad (hip flexion, abduction, adduction, extension)
  • Modalities for pain and edema control

Plan: (2-6 weeks)

  • Soft tissue/scar mobilization
  • Prone/standing knee flexion
  • Proprioceptive training/ balance — BAPS, trampoline
  • Weight shifting in standing, 0-30° ROM mini squats
  • EMS co-contraction at VMO and hamstrings’
  • Theraband ankle exercises – progress to standing as WB dictates
  • Begin Stairmaster at 4 weeks
  • General conditioning
  • Aquatic therapy (when incisions healed) No whip kick

Phase II (6-12 weeks)


  • Decrease swelling and prevent atrophy
  • Increase ROM -125°
  • Increase quadriceps and hamstring strength
  • Increase hip strength
  • Stimulate collagen healing
  • Independent ambulation without crutches
  • Continue general conditioning


  • Continue phase I exercises
  • Continue patellar mobilization and ROM activities
  • Continue hamstring and calf stretching
  • Standing ½ squat
  • Joint and soft tissue mobilization as needed
  • Isotonic hamstring NK table, Leg press
  • Continue closed chain, balance and proprioceptive activities
  • Continue EMS as needed for muscle re-ed and edema
  • Step-ups (controlled – forward and side)
  • *McConnell tapping as necessary)
  • May begin swimming with modified kick (No “whip kick” or “egg beater kick”)
  • General conditioning

Phase III (12-16 weeks)


  • Full ROM
  • Continue all goals from Phase II
  • Plan
  • Continue phase II exercises and progress as tolerated
  • Step-Up – side and down
  • Increase proprioceptive training (sport cord, body blade, plyoballs)
  • Treadmill as tolerated
  • Continue Stairmaster
  • ½ wall sits as tolerated

Plan (16-20 weeks)

  • Light jogging on trampoline
  • ¼ to 1/2 squats (painfree)
  • Progress with closed chain activity
  • Isotonic terminal knee extension (30-0°)

Phase IV (20-36 weeks)


  • Development of strength, power and endurance
  • Begin to prepare for return to recreational activity
  • Begin sport specific training


  • Continue Phase III exercise and conditioning activities
  • Continue strength training
  • Initiate running program
  • Initiate agility drills
  • Sport specific training and drills
  • Isokinetic evaluation


PT twice weekly x 6 weeks
Advance to FWB as Quad control allows
**TTWB x 6 wks if Meniscus Repair

Please forward a progress report via fax or e-mail at least one day prior to the next MD visit or give to the patient to hand deliver.